This proposal represents a career development award for Dr. Mina Hosseinipour, under the mentorship of Dr. Myron S. Cohen of the University of North Carolina and Dr. Peter Kazembe of the Lilongwe Central Hospital and the Malawi College of Medicine in Malawi, to pursue research experience in Malawi related to HIV/AIDS and parasitic infection. HIV/AIDS has devastated developing countries particularly in Sub- Saharan Africa. While antiretroviral therapy is slowly being introduced, basic medical care remains beyond the reach of most and preventable illnesses and endemic diseases continue to take their toll. The objective of this proposal is to evaluate the interaction between parasitic infection and HIV in Malawi and determine if parasitic infection, particularly helminth infections, adversely affect HIV progression either through virologic or immunologic mechanisms. The proposal encompasses epidemiology, immunology, virology and clinical care. Using a cross-sectional design, the prevalence of parasitic infections and HIV will be determined among the certain ambulatory clinic populations in Lilongwe, Malawi. Patients will be treated for identified infections and followed four weeks after this treatment for evaluation of clinical cure, and pre and post treatment immunologic and virologic measures can be compared. The objectives of this study are as follows: 1) to determine the prevalence of parasitic infection among HIV positive and negative patients 2) to determine if treatment of parasitic infection decreases HIV RNA 3) to determine if cytotoxic T lymphocyte responses and serum cytokine levels vary according to parasitic status and change in response to parasitic treatment. The composite of these objectives will serve to develop a predictive model to detect parasitic infections among HIV positive patients so that treatment algorithms can accurately detect these infections and improve health care delivery to HIV positive patients living in Malawi. [unreadable] [unreadable]